North Carolina prods obese workers, smokers toward healthier lifestyles

RALEIGH — North Carolina is offering teachers and state employees cheaper and easier access to medication aimed at helping them lose weight and quit smoking.

The aid is a carrot that goes along with the stick the state is using to prod employees into healthier lifestyles: more expensive health insurance for tobacco users and the obese.

Smokers and their families move into a costlier health plan starting July 1, followed a year later by families of the state’s heaviest workers. State legislators approved the extra fees this spring.

Ahead of the first changes kicking in — and state government workplaces starting to test randomly for tobacco — the State Health Plan is offering its 661,000 members some help to avoid paying more.

Starting Jan. 1, generic nicotine patches will be free, patients won’t need state approval to get weight-loss drugs, and the cost of certain weight-loss and anti-smoking drugs will drop by $20.

“We’re trying to put as many aids out there as we can,” Health Plan Executive Administrator Jack Walker said Wednesday after briefing a legislative panel.

North Carolina will join a number of other states in charging more for smokers, and at least one, Alabama, in doing the same for the obese. Only one, though, Indiana, backs up its smoking requirements with random tests, Walker said.

Random tests for smoking

Walker told the panel that random testing will happen at off-site locations, not at workplaces.

“We want privacy protected,” Walker said.

State employees had raised privacy concerns. But the promise of off-site testing poses its own problems, the State Employees Association of North Carolina says: namely, the inconvenience of leaving the office or finding time after work.

Association spokeswoman Erica Baldwin said the state should trust employees’ self-reporting.

“I certainly think employees will be honest,” Baldwin said, “and I think the legislature and the state don’t need to be going into their workplaces and interrupting their work.”

Obese to pay more

Employees don’t face testing to prove their weight, Walker said. The plan will depend on the honor system, unless the legislature approves random weight testing.

Workers with a high body mass index, starting in 2011 at a BMI of 40 and decreasing to 35, will pay the higher fees, on average about 9 percent more than their trimmer colleagues.

Those with medical conditions or who are actively working to lose weight, like those trying to quit smoking, can seek an exemption.

Jim Pressley, of Cullowhee, a computer consultant for the Department of Transportation, expects his costs to go up because his 6-foot-tall frame tips the scale at more than 300 pounds.

“They’re punishing us for, sometimes, things that are beyond our control,” Pressley said.

He said a recent hip replacement, and a knee that will soon need replacing as well, make exercise tough for him.

Saves state money

At least 12 percent of health plan members younger than 65 use tobacco and 32 percent are obese, according to the health plan. Each smoker costs the plan $2,660 a year and each obese member costs $1,000, the plan says.

The plan expects to save $13 million by charging smokers more next year and $5 million-$8 million a year by targeting the obese in future years.

Sen. Tom Apodaca said something has to be done to bring healthier people into the plan, which was headed for insolvency this year before legislators bailed it out with a cash injection and fee hike, part of the bill that made the smoking and weight changes.

But Apodaca, who voted against the bill, says requirements are being piled on to employees too quickly. He knows from personal experience it’s tough to put down the cigarettes and shed pounds, he said.

A health plan member, Apodaca said he won’t be subject to the extra costs. A random test of him won’t find anything, the Hendersonville Republican said, unless it can detect Nicorette chewing gum.

The employees’ association says the higher co-payments and deductibles starting in July – about $40 per month for smokers – will disproportionately hit the poor, who are more likely to smoke and weigh more.

Help with quitting, losing

The group applauded the help paying for medications, but said it may not be enough.

“There are many state employees who are in such a low income group that if you really want this to work, you’ve got to make these medications available at virtually no cost,” said Chuck Stone, a lobbyist with the association.

Legislators have asked the health plan to figure out the cost of providing the drugs without any co-payment, House Majority Leader Hugh Holliman said.

For now, co-payments for certain brand-name drugs, such as the weight-loss medications Meridia and Xenical, will drop to $35.

They cost $55 now, and patients need the plan’s permission to get the weight-loss drugs. Starting Jan. 1 only a doctor’s prescription will be needed.

Pressley questioned whether such drugs would be safe, especially for someone like him who takes drugs to lower his blood pressure and cholesterol.

The drugs are approved by the Food and Drug Administration. Consumer group Public Citizen has pushed unsuccessfully for the FDA to ban Meridia because of side effects of increased blood pressure and heart rate.

Eight months’ worth of generic-brand nicotine patches will be free through the state’s Tobacco Use Quitline, which also offers coaching for smokers hoping to quit.

In addition to the cheaper drugs, the plan will cover four visits per year to nutritionists at the cost of primary care. And plan members get discounts for diet and fitness clubs.

“If you want to be engaged, it’s there,” Walker told the legislative panel. “The challenge for all of us is, how do you get people engaged in healthy behavior?”

By Jordan Schrader
December 3, 2009